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Invited Commentary
February 5, 2020

Improvement of Cardiovascular Functional Reserve After Kidney Transplant—Has the CAPER Been Solved?

Author Affiliations
  • 1Department of Medicine, American Heart Association Comprehensive Hypertension Center, University of Chicago Medicine, Chicago, Illinois
  • 2Section of Nephrology, University of Chicago Medicine, Chicago, Illinois
JAMA Cardiol. 2020;5(4):430-431. doi:10.1001/jamacardio.2019.5874

In this issue of JAMA Cardiology, Lim and colleagues1 report on cardiovascular functional reserve in people with end-stage renal disease before and after kidney transplant. They performed a 3-arm, prospective, concurrent cohort study to assess change in cardiovascular functional reserve after kidney transplant using state-of-the-art cardiopulmonary exercise testing (CPET). They also assessed left ventricular morphologic findings 1 year after transplant. They enrolled 81 participants with stage 5 chronic kidney disease (CKD) who underwent kidney transplant, 85 wait-listed participants with stage 5 CKD who had not undergone transplant, and 87 controls treated for hypertension only. The authors quantified cardiovascular functional reserve using CPET in parallel with transthoracic echocardiography. One year after transplant, a significant improvement in maximum oxygen consumption was found in the transplant group compared with the nontransplant group. Moreover, left ventricular function improved but not the body mass index.